From the Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia.
Child health department, Sultan Qaboos University Hospital, Muscat, Oman.
Pediatr Infect Dis J. 2020 Jun;39(6):500-506. doi: 10.1097/INF.0000000000002605.
Bloodstream infection (BSI) is one of the leading causes of morbidity and mortality in children. This study was done to assess the local epidemiology and outcome of BSIs managed at a large specialist pediatric hospital with a focus on community-onset BSI.
We retrospectively reviewed laboratory-confirmed BSI in children (0-18 years) at The Children's Hospital at Westmead over a 3-year period (2014-2016). Laboratory data and patient medical records were used to determine BSI rates, blood culture contamination rates, patient demographics, isolate profile, antimicrobial resistance and mortality rate in this cohort.
In total, 47,368 blood cultures were collected; 1027 (2.2%) grew probable contaminants and 991 (2.1%) grew clinically significant isolates. Clinically significant bacteremia accounted for 4.8 per 1000 admissions, with 391 children managed for 465 culture-proven BSI episodes. One hundred thirty-one (28.2%) episodes were community-onset community-associated, and 334 (71.8%) were either community-onset healthcare-associated (HCA) (187; 40.2 %) or hospital-onset (147; 31.6%). Of the significant isolates, 243 (52.3%) were Gram-positive bacteria, 198 (42.6%) were Gram-negative bacteria, 6 (1.3%) were polymicrobial infections and 18 (3.9%) were yeast. Staphylococcus aureus (115; 24.7%) and Escherichia coli (54; 11.6%) were the most common organisms identified. Osteoarticular infection (44; 33.6%) and urosepsis (23; 17.6%) were the most frequent sites of infection associated with non-HCA BSI. Mortality at 30 days was reported in 15 (3.3%) children, all whom had preexisting comorbidities.
The majority of BSI episodes managed in our hospital were either community-onset HCA or hospital-onset infections. This highlights the considerable importance of infection control and central venous catheter device care initiatives. Among community-associated BSI, S. aureus in association with osteoarticular infection was predominant.
血流感染（BSI）是导致儿童发病和死亡的主要原因之一。本研究旨在评估一家大型儿科专科医院管理的血流感染的局部流行病学和结局，重点关注社区获得性血流感染。
我们对西悉尼儿童医院（The Children's Hospital at Westmead）在 3 年期间（2014-2016 年）的实验室确诊的儿童（0-18 岁）血流感染进行了回顾性研究。实验室数据和患者病历用于确定该队列的血流感染率、血培养污染率、患者人口统计学特征、分离物特征、抗生素耐药性和死亡率。
共采集了 47368 份血培养，1027 份（2.2%）为可能的污染物，991 份（2.1%）为临床有意义的分离物。临床显著菌血症的发病率为每千例住院患者 4.8 例，有 391 名儿童因 465 例培养阳性的血流感染接受治疗。131 例（28.2%）为社区获得性社区相关感染，334 例（71.8%）为社区获得性医疗保健相关（HCA）（187 例；40.2%）或医院获得性（147 例；31.6%）。在有意义的分离物中，243 株（52.3%）为革兰阳性菌，198 株（42.6%）为革兰阴性菌，6 株（1.3%）为混合感染，18 株（3.9%）为酵母。金黄色葡萄球菌（115 株；24.7%）和大肠杆菌（54 株；11.6%）是最常见的病原体。非 HCA BSI 相关的最常见感染部位为骨关节炎感染（44 例；33.6%）和尿脓毒症（23 例；17.6%）。30 天死亡率为 15 例（3.3%），均为存在合并症的儿童。
我们医院管理的大多数血流感染为社区获得性 HCA 或医院获得性感染。这突出了感染控制和中心静脉导管装置护理计划的重要性。在社区相关性血流感染中，金黄色葡萄球菌与骨关节炎感染相关。
